Conviction and controversy

When C. Everett “Chick” Koop died Feb. 25 at his home near Dartmouth University, the 96-year-old left behind a multi-layered legacy. The layers include pioneering work in pediatric surgery, his writings, his influential but sometimes controversial role as surgeon general under President Ronald Reagan 1981-1989, and a late-in-life role lobbying against the healthcare law passed in 2010. The overarching layer for Koop was his Christian faith and a worldview shaped by it. An evangelical Presbyterian, Koop rose to national prominence unalterably committed to belief in the sovereignty of God.

Koop was born in Brooklyn Oct. 14, 1916, the only child of a banker. He later told reporters he had been raised in a Christian home, but had no idea what that meant. Growing up he attended a Baptist church, but didn’t know why. He graduated from Dartmouth College, Cornell’s medical college, and the University of Pennsylvania medical school in Philadelphia. Along the way, he married Elizabeth “Betty” Flanagan, a Vassar student from Connecticut. They had three sons and a daughter. One son, David, died in 1966 at age 20 in a mountain-climbing accident near Dartmouth. Koop and Betty wrote a book about their “grief and faith amid despair,” Sometimes Mountains Move.

In Philadelphia, a nurse invited Koop to visit Tenth Presbyterian Church in the city’s center. He did, he liked what preacher Donald Grey Barnhouse had to say, and during a return visit realized that what he heard made sense. He had become a believer. The Koops settled into the church, and “Chick” (a boyhood nickname derived from “chicken Koop”) eventually became an elder in the church, which at the time was part of the mainline Presbyterian denomination but would eventually join the Presbyterian Church in America.

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Koop became internationally renowned in medicine, a pioneer and innovator in pediatric surgery at Children’s Hospital in Philadelphia. Beginning in 1947, he spent 35 years at Children’s as chief of surgery (and also served as professor of pediatrics at the nearby University of Pennsylvania medical school). He and his teams performed thousands of operations to correct until-then fatal birth defects and other problems in newborns.

In 1962 Koop established the first surgical neonatal intensive care unit in the country. He and his colleagues made national headlines in separating several sets of conjoined twins. He trained dozens of doctors who went on to head pediatric surgery departments across the country, and became founding editor of the Journal of Pediatric Surgery.

His faith and his life-saving work with newborns helped to shape his conviction that abortion and infanticide are wrong. In 1948, he diagnosed and surgically treated a sick young girl whose condition baffled other doctors. The girl was the daughter of theologian and philosopher Francis Schaeffer—and Koop and Schaeffer went on to develop a long friendship. In 1979, they published a book and produced a film series, both titled Whatever Happened to the Human Race? The bestseller raised the specter of infirm elderly adults someday being deprived of medical care and left to die. Three years earlier, Koop had written another book that rallied others to the pro-life cause, The Right to Live; the Right to Die.

One of those who read those two books was newly elected President Ronald Reagan. He needed a surgeon general and wondered if Koop would be a good fit. Reagan asked his pastor, Don Moomaw of Bel Air Presbyterian Church in California, to survey how other leaders felt about Koop. Their verdict: Go for it.

That was not the public reaction to Reagan’s announcement of Koop’s nomination. Abortion-rights advocates and feminists were furious. Editorials in newspapers across the country denounced the choice—even though the surgeon general had no real power, and the office was seen as a bully pulpit. The nomination was tied up in congressional hearings for months. Koop used the time to observe how Washington works, to study the issues, and to strategize. He realized he had been appointed to be surgeon general of all the people, and if he were to try to influence and communicate to everybody, some compromises might be necessary. Koop’s nomination finally met with congressional approval in late 1981. When he resigned in 1989 (because he failed to secure the job he wanted as Secretary of Health and Human Services), the situation had reversed: The media and many liberals praised him as America’s greatest surgeon general, while many conservatives complained they had been betrayed.

The complaints by conservatives centered on issues where Koop had backed away from his earlier public pro-life rhetoric in favor of seeking compromise solutions. One was known as Baby Doe, in which doctors and families in two cases agreed to withhold nourishment from babies born with defects. The babies died. Clear cases of infanticide in the minds of many, including Koop. Yet courts kept shooting down regulations aimed at preventing it. Koop then proposed a compromise, involving “patient-care communities” within hospitals. But the U.S. Supreme Court nixed that idea, too.

Many in the pro-life movement were appalled that Koop would propose any compromise that would still involve the deliberate death of a child.

Another complaint concerned a report on the health effects of abortion on women requested by Reagan for Koop to research for the president’s private review.

After prolonged study, Koop submitted his findings to the president in a letter delivered to the White House. It concluded, “I regret, Mr. President, in spite of a diligent review on the part of many in the PHS [Public Health Service] and in the private sector, the scientific studies do not provide conclusive data about the health effects of abortion on women.”

Someone leaked the letter to the press before Reagan received it. Reports circulated immediately, announcing, “Koop says abortion does not harm women.”

It was one of several controversial pronouncements, as Koop published groundbreaking reports on the hazards of tobacco use, on infanticide, and on the emerging epidemic of HIV/AIDS. “My whole career had been dedicated to prolonging lives ... especially the lives of people who were weak and powerless, the disenfranchised who needed an advocate: newborns who needed surgery, handicapped children, unborn children [and] people with AIDS.”

Koop resigned in 1989, and he and his wife, Betty, returned to Philadelphia, where he puttered in business ventures, charitable work, and writing. In 1995 President Bill Clinton awarded him the Medal of Freedom.

Betty became seriously ill, and the couple moved to Hanover, N.H., where she died in 2007. Three years later, Koop married Cora Hogue, director of adult education at Tenth Presbyterian.

At age 93 he entered the public arena again, this time as a vocal opponent of Obamacare, with videotaped spots of his own testimonial: “I’m 93 and thank God for every year. I’m here with two artificial joints, two pacemakers to keep my heart in rhythm, as well as a stent to keep my coronaries open,” he said, noting that in other countries with nationalized healthcare, he would be “considered too old and the cost to the state too high.”

The spots were widely redistributed, showing again, as Washington Post columnist Michael Gerson pointed out upon his death, that Koop was perhaps the only U.S. Surgeon General whom Americans will readily remember.